Northwest Medical Center: 30-minute ER promise

Northwest Medical Center

Working to improve efficiency, the Northwest Medical Center
started making a commitment to see emergency room patients in 30
minutes or less. After starting the goal in October, hospital
officials are happy with the success.

Al Petrillo/Special to The Explorer

Northwest Medical Center

Northwest Medical Center continues to fulfill its promise to see
emergency room patients in 30 minutes or less since last October,
and plans to continue the program through 2012 and the foreseeable
future.

Kim Chimene, marketing director for the Northwest Medical
Center, said they started the program last October “after
realigning some of our ER processes so that we could get patients
to see a physician much faster.”

Chimene pointed out that wait times in many emergency rooms
around the country have been increasing, and that Northwest’s ER
service pledge was a way for the facility “to provide quality care
as efficiently as possible.”

Northwest’s 30 Minutes or Less ER Service Pledge means that when
a patient enters the ER, the time of their arrival is noted, which
starts the clock ticking.

Joe Akif, R.N., administrative director of the Emergency
Department, said the ER staff works diligently to have a physician
initially see a patient and begin their evaluation and treatment
within the 30-minute window.

“Some of the other hospitals affiliated with our group have done
this across the country and we knew we could deliver on this pledge
most of the time,” Akif said.

In the Tucson region, Northwest Medical Center and Oro Valley
Hospital are both owned by Community Health Systems.

Akif pointed out that most emergency rooms are based on nurse
triage, where a nurse is the first point of contact with a patient
for treatment.

“When people come to the ER, they come to see a doctor, not a
nurse,” Akif said. “We changed the process so the physician is on
the front end of the process instead of at the end of it. And that
means within 30 minutes the patient will be eye-to-eye with a board
certified ER physician.”

Akif said that in the five months that Northwest has had the 30
Minutes or Less Pledge, wait times in the ER have averaged between
16 and 22 minutes, depending on the time of year, day and hour.

“The best wait time we’ve done through this program is 14
minutes,” he said.

“In the evening, we typically will see six to eight patients an
hour, but sometimes, on busy nights, that might go up to between 20
and 24 patients an hour.”

While the pledge is to have a maximum 30-minute wait time before
seeing a physician, Akif conceded that infrequently that time
window cannot be met.

“The most severe cases in an ER will always receive immediate
attention,” he said, which could have an impact on wait times, for
instance, if trauma victims are brought to the ER.

Northwest Medical Center’s ER is a busy one, averaging 180
patients a day, with a typical load between 145 and 150 patients
per day.

Akif said ERs classify patients on the basis of nursing acuity
in a 0 to 4 scale, with 4 being the most serious.

“Our nursing acuity average is a 3.7” he said. “We see a pretty
sick population here. We have the benefit of four urgent care
centers located around us, so we wind up with more acutely ill
patients. We also see a lot of ambulance traffic through our
ER.”

But patients are getting in and out of Northwest’s ER in a more
timely manner, Akif said.

”We’ve been able to cut an hour and a half off the total time of
the average patient being seen in the ER and then discharged,” he
said. “We’ve also been able to cut three hours off the wait for an
in-patient bed, so now the wait is only an hour-and-a-half.”

Akif noted that 18.5 percent of the patients seen in Northwest’s
ER are admitted to the hospital, a figure that makes up 50 percent
of the hospital’s admissions. Sixteen percent of ER patients
becoming in-patients is the national norm, he said.

Northwest’s ER also has a discharge call-back program where
hospital staff phone a patient within 72 hours of discharge from
the ER to follow up on their care, as well as an ER outpatient
survey.

“We call to see how they are doing, if they filled prescriptions
when needed, see if they set up follow-up appointments with their
primary care doctor, and if they got what they needed from us and
if it helped,” Akif said.